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South Dakota rates for HCPCS A6261

Wound Filler Gel/Paste Per Fluid Ounce Not Otherwise Specified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $1.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $1.85 / $1.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.50 / $21.50 / $26.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.00 / $38.63 / $48.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $3.14 / $5.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.87 / $22.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.65 / $4.55 / $6.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $4.55 / $5.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.73 / $2.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.59 / $4.59 / $4.59